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. 2022 Apr;70(4):1239-1245.
doi: 10.4103/ijo.IJO_1470_21.

Incidence and risk factors for post-penetrating keratoplasty glaucoma

Neha Shree  1 , Monica Gandhi  1 , Abhishek Dave  1 , Umang Mathur  1
Affiliations

Incidence and risk factors for post-penetrating keratoplasty glaucoma

Neha Shree et al. Indian J Ophthalmol. 2022 Apr.

Abstract

Purpose: To carry out a prospective study to analyze the incidence and various preoperative, intraoperative, and postoperative risk factors for the development of PPKG.

Methods: A total of 207 patients were analyzed prospectively, who were operated for penetrating keratoplasty (PK) in a tertiary eye care hospital between the time period of August 1, 2017 and February 28, 2018 and were followed up till the sixth month. Each patient was analyzed at every visit to determine the factors responsible for post-keratoplasty glaucoma.

Results: Out of 207 eyes, post-PK glaucoma developed in 84 cases, which yielded an incidence of 41%. Incidence of PPKG (Post PK glaucoma) in various conditions was as follows: in repeat PK 62%, in perforated corneal ulcer 33%, in nonperforated corneal ulcer 29%, in corneal scar including adherent leukoma 37.2%, and in pseudophakic bullous keratopathy and aphakic bullous keratopathy, 14% and 80%, respectively. In age- and sex-adjusted multivariate analysis, the significant risk factors were age (P-value- 0.006), presence of PAS (P-value 0.001), and fellow eye glaucoma (P-value 0.04). Aphakia and combined surgery were not found to be significant.

Conclusion: Our study recommends a meticulous examination of the fellow eye to assess the presence of glaucoma as it can increase the suspicion of glaucoma in the eye to be operated. The presence of PAS and age are important risk factors for developing PPKG. The risk of developing PPKG increases exponentially as the number of risk factors increases, but the presence of more than three risk factors does not add to the development of PPKG.

Keywords: Glaucoma; optical keratoplasty; penetrating keratoplasty; post-PK glaucoma; therapeutic penetrating keratoplasty.

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Conflict of interest statement

None

Figures

Figure 1
Figure 1
(a) Postoperative image of eye treated with optical penetrating keratoplasty for corneal scar. (b) Three months later, the patient underwent successful trabeculectomy surgery for post-PK glaucoma showing well-formed bleb. PK = penetrating keratoplasty
Figure 2
Figure 2
(a) Ahmed glaucoma valve (A GV) implantation in a patient with post-PK glaucoma. (b) AGV tube well placed in sulcus
Figure 3
Figure 3
(a) Post-PK patient with 360° PAS developed secondary angle closure post-PK glaucoma. (b) Treated with trabeculectomy with Mitomycin-C (MMC), well-formed bleb can be seen
See this image and copyright information in PMC

Comment in

References

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